SUO > Prostate > Flashcards

Prostate Flashcards

(47 cards)

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1
Q

PCa

Localized Workup

6

A
  • H&P including DRE
  • Labs including PSA and PSAD
  • Review PBx
  • Estimate Life Expectancy
  • Obtain FH (Somatic and germline testing if needed)
  • Assess QoL
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2
Q

PCa

Regional and Metastatic Workup

6

A
  • H&P including DRE
  • Labs including PSA and PSAD
  • Imaging (CT/ Bone Scan, mpMRI, PSMA-PET)
  • Estimate Life Expectancy
  • Obtain FH (Somatic and germline testing if needed)
  • Assess QoL
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3
Q

PCa

Low Risk Treatment

4

A
  • Active Surveillance (p)
  • RT (EBRT or Brachytherapy)
  • RP
  • Observation (< 10y Life expectancy)
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4
Q

PCa

PCa Epidemiology

2

A
  • Incidence- 288,300 new cases (1 in 8)
  • Deaths- 34,700 deaths (1 in 41)
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5
Q

PCa

Grade Groups for PCa

5

A

Grade group 1: 3+3
Grade group 2: 3+4
Grade group 3: 4+3
Grade group 4: Gleason 8 (3+5, 5+3, 4+4)
Grade group 5: Gleason 9 or 10 (4+5, 5+4, 5+5)

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6
Q

PCa

PCa T1 staging

3

A

T1a → <5% of tissue removed, incidental during unrelated sx

T1b → >5% of tissue removed, incidental during unrelated sx

T1c → cancer found on biopsy, usually related to elevated PSA

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7
Q

PCa

PCa T2 staging

3

A

T2a → in only < 50% of one lobe

T2b → in > 50% of one lobe

T2c → cancer in both lobes

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8
Q

PCa

PCa T3 staging

2

A

T3a → Extracapsular extension

T3b → SV invasion

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9
Q

PCa

PCa T4 staging

1

A

T4 → spread to nearby organs (rectum, bladder, levator muscles, pelvic wall)

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10
Q

PCa

N staging

1

A

N1 -> Regional LN metastasis

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11
Q

PCa

M staging

3

A

M1a -> non-regional LN metastasis
M1b -> boney metastasis
M1c -> Viseral metastasis

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12
Q

PCa

PCa Risk Stratification → Very Low Risk

6

A

Very Low Risk must have all:
* PSA < 10
* GG1 (Gl 6)
* T1-T2a
* < 34% total biopsy cores positive
* no core >50% involved
* PSA density < 0.15

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13
Q

PCa

PCa Risk Stratification → Low Risk

3

A

Low Risk must have all:

  • PSA < 10
  • Grade Group 1
  • T1-T2a
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14
Q

PCa

PCa Risk Stratification → Intermediate Risk

5

A

Intermediate Risk:

  • PSA 10-20 OR
  • GG 2-3 OR
  • T2b-c
  • Favorable GG1: (with PSA 10 - <20) or GG2, <50% positive cores
  • Unfavorable: >50% positive cores or T2b-c or GG3 (PSA < 20)
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15
Q

PCa

PCa Risk Stratification → High Risk

3

A

High Risk:

  • PSA >20 OR
  • GG 4-5 OR
  • _>_T3
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16
Q

PCa

PCa Epidemiology

2

A
  • Incidence- 288,300 new cases (1 in 8)
  • Deaths- 34,700 deaths (1 in 41)
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17
Q

PCa

PCa African Ancestry Disparties

6

A
  • Incidence 60-70% higher
  • Mortality 2-4 times higher
  • 1.2-5.1 years earlier diagnosis
  • More aggressive
  • Increased risk of metastatic progression
  • More advanced at presentation
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18
Q

PCa

PCa Biomarker Tests

10

A
  • PSA (blood)
  • fPSA (blood)
  • PCA3 (urine)
  • PHI (blood)
  • 4k score (blood)
  • ExoDx (urine)
  • Select MDx (urine)
  • Confirm MDx (tissue)
  • IsoPSA (blood)
  • MyProstateScore (blood and urine)
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19
Q

PCa

ASAP and PIN risk

Study These Flashcards
A
  • ASAP- 40% cancer risk
  • PIN- 20-30% cancer risk
20
Q

PCa

Favorable Int Risk Treatment

3

Study These Flashcards
A
  • AS
  • EBRT or Brachytherapy
  • RP +/- LND
21
Q

PCa

Unfavorable Int Risk Treatment

4

Study These Flashcards
A

_>_10y LE
* RP + LND
* RT + 4-6m ADT (EBRT, EBRT with Brachytherapy boost, Brachytherapy)

<10y LE
* RT +4-6m ADT (EBRT)
* Watchful waiting

22
Q

PCa

High Risk Treatment

6

Study These Flashcards
A

> 5y or symptoms
* RP + LND
* RT + 1.5-3y ADT (EBRT, EBRT with Brachytherapy boost)
* RT + 3y ADT + Abiraterone (very high risk)

_<_5y and no symptoms
* Watchful waiting
* ADT
* EBRT

23
Q

PCa

cN1 Treatment

6

Study These Flashcards
A

> 5y or symptoms
* EBRT + 3y ADT + Abiraterone (p)
* EBRT + 1.5-3y ADT
* ADT + Abiraterone
* RP + LND (select pts)

_<_5y and no symptoms
* Watchful waiting
* ADT

24
Q

PCa

List of Post-RP adverse features

4

Study These Flashcards
A
  • Positive margin
  • Extracapsular extension
  • SV invasion
  • Detectable PSA
25
# PCa Adjuvant therapy post RP with adverse features or N1 | 4
Adverse features * Monitoring (p) * EBRT +/- ADT N1 * Monitoring * ADT +/- EBRT
26
# PCa Post RP PSA persistence/recurrence (3 scenarios) | 5
Imaging negative * EBRT +/- ADT 3y (p) * Monitoring Fossa recurrence * EBRT +/- ADT 3y (p) * Monitoring Pelvic LN mets on imaging * EBRT + ADT 3y +/- Abiraterone
27
# PCa Post RT PSA Recurrence | 6
Imaging negative * Consider prostate/SV biopsy and monitoring * ADT based on PSADT * Local secondary treatment Pelvic LN mets on imaging * Consider prostate/ SV biopsy and monitoring * ADT +/- Abiraterone * Local secondary treatment +/- ADT
28
# PCa M0 CSPC s/p maximal pelvic therapy | 3
* Monitoring (p) * ADT * Enzalutamide + ADT (select pts)
29
# PCa M0 CRPC s/p maximal pelvic therapy | 3
PSADT > 10m * ADT + Monitoring (p) * ADT + Secondary hormone therapy PSADT< 10m * ADT + Apalutamide or Darolutimide or Enzalutimide
30
# PCa High volume PCa definition | 2
* Visceral metastasis * >/= 4 bone lesions with at least 1 beyond the vertebral body/ pelvis | Based on CHAARTED criteria
31
# PCa High volume M1 CSPC (synchronous or metachronous) | 2
* ADT + Docetaxel + Abiraterone or Darolutimide * ADT + Abiraterone or Apalutamide or Enzalutimide
32
# PCa Low volume M1 CSPC (synchronous) | 3
* ADT + Docetaxel + Abiraterone or Darolutimide * ADT + Abiraterone or Apalutamide or Enzalutimide * ADT + EBRT to primary +/- Abiraterone or Docetaxel
33
# PCa Low volume M1 CSPC (metachronous) | 1
* ADT + Abiraterone or Apalutamide or Enzalutimide
34
# PCa Denovo M1 CSPC Workup | 7
* H&P including DRE * Labs including PSA and PSAD * Imaging (CT/ Bone Scan, mpMRI, PSMA-PET) * Estimate Life Expectancy * Obtain FH * Somatic and germline genetic testing * Assess QoL
35
# PCa LHRH Agonist vs Antagonist | 5
Agonist * Leuprolide (Lupron) * Goserelin (Zoladex) * Triptorelin (Trelstar) Antagonist * Degarelix (Firmagon) * Relugolix (Orgovyx)
36
# PCa SHIM score | 12
* Sexual Health Inventory for Men * 5 questions, score 1-5 * confidence in getting and keeping an erection? hard enough for penetration? maintain erection after penetration? maintain erection to completion? satisfaction? * 1-7: severe * 8-11: moderate * 12-16: mild-moderate * 17-21: mild * 22-25: no ED
37
# PCa IPSS score | 13
* International prostate symptom score * 7+1 questions * Incomplete emptying? frequency less than 2 hours? intermittent stream? urgency? weak stream? strain? nocturia? bother? * 0-7: mild * 8-19: moderate * 20-35: severe
38
# PCa M1 CRPC pre-treatment workup | 4
* Metastatic lesion biopsy * Somatic testing for homologous recombination repair (HRR), microsatellite instability (MSI)/ mismatch repair deficiency (dMMR) and tumor mutational burden (TMB) * Continue ADT * Denosumab (p) or Zoledronic acid +/- palliative RT
39
# PCa Small cell/ neuroendocrine prostate cancer | 4
* Cisplatin/ etoposide * Carboplatin/ etoposide * Docetaxel/ carboplatin * Cabazitaxel/ carboplatin
40
# PCa M1 CRPC treatment (no prior docetaxel/ no prior novel hormone therapy) | 9
* Abiraterone (p) * Docetaxel (p) * Enzalutimide (p) * Niraparib/ abiraterone (BRCA) * Olaparib/ abiraterone (BRCA) * Pembrolizumab (MSI-high/ dMMR) * Radium-223 (symptomatic bone mets) * Sipuleucel-T (minimal symptoms) * Talazoparibe/ enzalutimide (HRR)
41
# PCa M1 CRPC treatment (failed prior docetaxel/ no prior novel hormone therapy) | 11
* Abiraterone (p) * Cabazitaxel (p) * Enzalutimide (p) * Cabazitaxel/ carboplatin * Mitoxantrone (palliative) * Niraparib/ abiraterone (BRCA) * Olaparib/ abiraterone (BRCA) * Pembrolizumab (MSI-high/ dMMR) * Radium-223 (symptomatic bone mets) * Sipuleucel-T (minimal symptoms) * Talazoparibe/ enzalutimide (HRR)
42
# PCa M1 CRPC treatment (no prior docetaxel/ failed prior novel hormone therapy) | 10
* Docetaxel (p) * Olaparib (BRCA) (p) * Rucaparib (BRCA) (p) * Cabazitaxel/ carboplatin * Niraparib/ abiraterone (BRCA) * Olaparib (HRR) * Pembrolizumab (MSI-high/ dMMR) * Radium-223 (symptomatic bone mets) * Sipuleucel-T (minimal symptoms) * Talazoparibe/ enzalutimide (HRR)
43
# PCa M1 CRPC treatment (failed prior docetaxel/ failed prior novel hormone therapy) | 9
* Cabazitaxel (p) * Docetaxel rechallenge (p) * Cabazitaxel/ carboplatin * Lutetium Lu 177 vipivotide tetraxetan (PSMA + lesions) * Mitoxantrone (palliative) * Olaparib (HRR) * Pembrolizumab (MSI-high/ dMMR/ TMB >10) * Radium-223 (symptomatic bone mets) * Rucaparib (BRCA)
44
# PCa Germline testing | 9
* BRCA 1/2 * ATM * PALB2 * CHEK2 * HOXB13 * MLH1 * MSH2 * MSH6 * PMS2
45
# PCa Somatic Tumor Testing | 5
* HRR (BRCA 1/2, ATM, PALB2, FANCA, RAD51D, CHEK2, CDK12) * MSI-H * dMMR * TMB * ctDNA
46
Ductal Carcinoma | 2
* is associated with high grade disease and recurrence * should be graded as 4+4
47
Outcomes of genomic testing
* Oncotype Dx- likelihood of Gleason 3+4 or ECE at prostatectomy * Decipher and Prolaris- likelihood of mets or CSS * Confirm MDx and Mitomic- likelihood of cancer after negative biopsy
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